11s 
OHSEKVATIONS ON KALA-AZAK IN KASSALA J'KOVINCE 
Aorta. Yellowish tinge, small raised patches (1 to 4 mm. long) beneath the internal 
coat. 
Liver. Weight 5 lb. Much enlarged, slightly nutmeg. Marked fatty degeneration, 
especially noted in right lobe. No amyloid degeneration. 
Spleen. Enlarged, weight 2 lb. 3 oz. ; dark maroon ; soft, hut not diffluent. No sign of 
position of spleen puncture. 
Stomach. Normal, hut a large gland (?) 3 inches long, 1 inch broad, and inch thick 
beneath suhinncosa on lower border of anterior wall. 
L’nrictal and Viscera! Feritoneuiii showed many small suh-peritoneal hamiorrhages. 
Diiodeniim. Two inches from the pylorus there w’ere two small ulcers (| inch by i- inch 
and I inch by /g inch) with shelving edges, red bases, and apparently of not very acute 
formation. 
The subjacent peritoneum was not thickened, and presented no tubercles. Probably 
the epigastric pain complained of four days before death was due to these ulcers. 
Small Intestine. Marked congestion near the ileociecal valve, with a few submucosal 
luemorrhages. 
l,ari/e Intestine. Intense congestion of Ctecinn and first eighteen inches of colon. 
.Vppendix normal. 
Lymphatic (Hands. These, draining the small intestine, were all greatly enlarged 
(i inch to inch long), of fleshy consistency, and deep maroon in colour. 
Kidneys. Each weighed about 9 oz., and presented no morbid appearances. 
Pancreas, ureters, bladder and prostate, healthy. Red marrow of bones, brain and 
spinal cord were not examined. 
Many specimens were taken and sent to Dr. Andrew Balfour for examination.' 
Smears were taken from liver and spleen, some were sent to Dr. Andrew Balfour and 
some examined here; and certainly it is a very striking fact that although some twelve 
hours were spent in examining various smears, in no case could 1 find anything similar to a 
Leishman parasite. Further, Dr. Balfour could not find any, though one of the films sent 
was too thick for proper examination. 
There is no doubt that the Leishman parasite was found in smears taken on 
December 30th, 1907, and Dr, Balfour verified this, his report lieing, “ unmistakable 
Leishman-Donovan bodies present.” 
Thus the very important point arises — Did the application of the hio-chemieal treatment 
free the patient from the parasites, though too late to prolong life and procure recovery? 
NOTES ON CASE IV 
Idkis Adaji, aged 2(1, An ah Policeman 
HISTORY- 
Sent to Mafaza, January, 1907. 
[jived in police tiikls. 
Fever started in August, 1!)07, and then was constantly present except for intervals of 
five to seven days. 
The medical orderly gave him daily quinine, 5-10 grains. 
He was sent from Mafaza on January 20th, 190S, and on admission to Kassala Civil 
Hospital on February 1st, 1908, he was found very emaciated and weak and suffering from 
fever {.see Chart, paye 116). 
Unfortunately all the tissues were clc.^troyed in the tire of IMay 11th.—A.B. 
